Hudson Jo-Anna B J, Shabbir Wardha, Hayawi Lamia M, Chan Monica Lik Man, Barrowman Nicholas, Sikora Lindsey, Ferretti Emanuela
Department of Pediatrics, Division of Neonatology, Memorial University, St. John's, Newfoundland, NF, Canada.
Department of OBGYN, Newborn Division, University of Ottawa, The Ottawa Hospital, Ottawa, ON, Canada.
Front Pediatr. 2024 Nov 22;12:1450121. doi: 10.3389/fped.2024.1450121. eCollection 2024.
Acquired spontaneous intestinal perforation or SIP occurs most commonly in the extremely premature infant population. As the incidence is rising, understanding modifiable factors such as common medication exposures becomes important for individualizing care.
The primary outcome was SIP in premature infants with exposure to indomethacin, ibuprofen, or acetaminophen. The systematic review and meta-analysis were conducted following the Cochrane methodology and PRISMA guidelines.
The point estimates of three RCTs showed an increase in the risk of SIP with indomethacin exposure compared to no medication, the pooled estimate was not statistically significant. There is no statistically significant association between the risk of SIP for indomethacin with treatment use over prophylactic use and when holding feeds. Ibuprofen conferred less risk than indomethacin, and its route of administration did not alter the risk profile. There was not enough evidence to draw conclusions about the risk of SIP and acetaminophen exposure.
In studies of infants exposed to either indomethacin or ibuprofen in the last 40 years, the incidence of SIP is still commonly within 2-8%. Moving forward modifiable factors such as medication exposure will help guide care to minimize risk where possible.
https://www.crd.york.ac.uk/, PROSPERO (CRD42017058603).
获得性自发性肠穿孔（SIP）最常见于极早产儿群体。随着发病率上升，了解如常见药物暴露等可改变因素对于个性化护理变得很重要。
主要结局是暴露于吲哚美辛、布洛芬或对乙酰氨基酚的早产儿发生SIP。按照Cochrane方法和PRISMA指南进行系统评价和荟萃分析。
三项随机对照试验的点估计显示，与未用药相比，暴露于吲哚美辛会增加SIP风险，但合并估计无统计学意义。吲哚美辛治疗性使用与预防性使用以及禁食时SIP风险之间无统计学显著关联。布洛芬的风险低于吲哚美辛，其给药途径未改变风险状况。没有足够证据就SIP风险和对乙酰氨基酚暴露得出结论。
在过去40年中对暴露于吲哚美辛或布洛芬的婴儿进行的研究中，SIP发病率通常仍在2%-8%之间。未来，如药物暴露等可改变因素将有助于指导护理，尽可能降低风险。
